Dentists Prescribe 10% of Outpatient Antibiotics but Lack Guidelines

​By staff

Atlanta—Efforts to improve antibiotic prescribing practices and thereby curb the spread of antimicrobial resistance often focuses on physicians and other primary care providers, such as nurse practitioners and physicians’ assistants, as well as specific medical specialists.

Often overlooked are dentists, who prescribe approximately 10% of outpatient antibiotics, notes an article published in the Journal of the American Dental Association.

A study team lead by researchers from the CDC notes that little is known about dentists’ antibiotic prescribing patterns. To remedy that, the authors conducted a study to characterize prescribing by dentists based on antibiotic agent and category, patient demographic characteristics, and geographic region in the U.S.

For the study, researchers identified oral antibiotic prescriptions dispensed during 2013 in the Xponent (Quintiles IMS) database. Then, the total number of prescriptions and county-level census population denominators were used to calculate prescribing rates.

Also analyzed was prescribing according to individual agent, drug category, and patient demographic characteristics as well as the overall number of prescriptions calculated for general dentists.

Results show that dentists prescribed 24.5 million courses of antibiotics in 2013, a prescribing rate of 77.5 prescriptions per 1,000 people. The most commonly prescribed antibiotic category was penicillin.

Most of the antibiotics were prescribed for adults aged >19 years, with the Northeast census region having the highest prescribing rate per 1,000 people. The District of Columbia had the highest prescribing rate of 99.5 per 1,000 people, and Delaware had the lowest prescribing rate of 50.7 per 1,000 people.

The study points out that, although dentists usually prescribe within recommended guidelines, they sometimes write prescriptions for antibiotics not indicated for dental conditions, such as fluoroquinolones and others usually reserved for conditions such as urinary tract infections.

“Dentists prescribe large quantities of antibiotics in outpatient settings, and there is considerable geographic variability,” study authors note. “Additional study is needed to better understand the reasons for this variability and identify areas of possible intervention and improvement.”

A CDC blog advises that guidelines have been published for dentists’ use of antibiotic prophylaxis for prevention of infective endocarditis and prosthetic joint infections, but little national guidance exists on treatment of specific dental infections.

Study authors emphasize that combating antibiotic resistance will require all prescribers, including dentists, “to examine prescribing behaviors for appropriateness and the effectiveness of guidelines to identify opportunities to optimize antibiotic use.”